Revised 05 Sept 2012
Please see the Colorectal Cancer Care Map for Physicians (below) developed by the BC Cancer Surgical Oncology Network and the accompanying text which is included in 8 Appendix.
- For patients with localized disease, the surgical standard of care is transabdominal resection of the involved segment of colon with at least 5 cm proximal and distal margins, with en bloc regional lymphadenectomy, usually with primary anastomosis.
- Adequate lymphadenectomy is facilitated by wide resection of the mesentery and high ligation of the vessels leading to the tumour, along with removal of clinically suspicious lymph nodes outside the field of resection.
- Laparoscopic or laparoscopic-assisted resection of colon cancer is considered technically and oncologically safe when performed by experienced surgeons who can concurrently perform thorough abdominal exploration and when the disease is not locally advanced or perforated.
- For those with metastatic disease, resection of asymptomatic primary tumours is not routinely recommended, although retrospective evidence is conflicting with some studies demonstrating an improved survival associated with resection of the primary tumour. In patients with obstructing colon cancer, palliative resection of the primary tumour or proximal diversion may be considered while patients with clinically significant bleeding may require resection.
- For selected patients with single organ metastases (stage M1a), resection of metastatic disease may be curative. Referral to BC Cancer for multi-disciplinary review is recommended.